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Frank Summers's emphasis in this book is on the clinical process. A detailed clinical example serves as an introduction to a focus that recurs throughout the volume—namely, a comparing and contrasting of the ego psychological approach, an object relations approach based largely on Winnicott's contributions, and the contemporary relational viewpoint.
From the ego psychological position, symptoms are seen as a neurotic compromise between drive-induced wishes and superego prohibition. The analytic task is to make the unconscious conscious, with the ego achieving greater mastery over unconscious derivatives and reaching more adaptive compromises. This allows for a greater degree of instinctual gratification. This is a one-person model, with inquiry focused entirely within the patient.
For relationalists, symptoms are compromises reflecting conflictual relational patterns between patient and analyst. Analyst and patient cocreate the clinical material, and both are inextricably embedded in the relational matrix. The goal is to broaden and enrich the patient's relational configuration. Therapeutic action lies primarily in this new relationship created by patient and analyst. Relationalists criticize ego psychology and other approaches as too narrowly focused on intrapsychic life and as undervaluing the inherently interactive nature of the self.
Summers's object relations theory views primary symptoms as rooted in early relationships. Object relations theorists seek to explore, understand, and create a new self-structure rather than facilitate a more enriching relationship. They aim to help the patient reject destructive patterns and replace them with patterns based on authentic experiences. They hold that the relationalists' focus on relational patterns blurs the